Abstract
Between 1982 and 1983, we experienced four cases of hemodynamic collapse accompanied by an ST-segment depression in the ECG lead II, shortly after the cessation of cardiopulmonary bypass. The bypass graft flows monitored in these patients during the hemodynamic collapse episodes were remarkably low. In three cases, nitroglycerin (0.5–1 mg) was injected directly into the vein graft, which increased the graft flow suddenly, returned the ST-segment to the baseline, and improved the circulatory condition. Since 1984, however, diltiazem has been used in the cardioplegic solution and postoperative drip infusion. Due to the introduction of this drug, coronary artery spasm has not been seen in any of our patients since. These findings show that the monitoring of ST-segment changes and bypass graft flows are useful in the early diagnosis of coronary artery spasm after myocardial revascularization. Direct infusion of nitroglycerin into the vein graft is effective for the treatment of spasm, while diltiazem is useful in the prevention of coronary artery spasm incidental to myocardial revascularization.
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Maseri A, Severi, S., De Nes M, L’abbate A, Chierchia S, Marzilli M, Ballestra AM, Parodi O, Biagini A, Distante A. “Variant” angina: one aspect of a continuous spectrum of vasospastic myocardial ischemia. Am J Cardiol 1978; 42: 1019–1035.
Hillis LD, Braunwald E. Coronary-artery spasm, N Engl J Med 1978; 299: 695–702.
Pichard AD, Ambrose J, Mindich B, Midwall J, Gorlin R, Litwak RS, Herman MV. Coronary artery spasm and perioperative cardiac arrest. J Thorac Cardiovasc Surg 1980; 80: 249–254.
Buxton AE, Goldberg S, Harken A, Hairshfeld JJ, Kastor TS. Coronary-artery spasm immediately after myocardial revascularization. N Engl J Med 1981; 304: 1249–1253.
Buxton AE, Hirshfeld JW Jr, Untereker WJ, Goldkerg S, Harken AH, Stephenson LW, Edie RN. Perioperative coronary arterial spasm: long-term follow-up. Am J Cardiol 1982; 50: 444–451.
Zingone B, Salvi A, Branchini B. Perioperative coronary artery spasm leading to myocardial ischemia after vein graft surgery. Br Heart J 1983; 49: 280–283.
Lewis BH, Muller JE, Rutherford J, Mudge GH Jr, Collins JJ Jr. Nifedipine for coronary-artery spasm after revascularization. N Engl J Med 1982; 306: 992–993.
Kopf GS, Riba A, Zito R. Intraoperative use of nifedipine for hemodynamic collapse due to coronary artery spasm following myocardial revascularization. Ann Thorac Surg 1982; 34: 457–460.
Cohen DJ, Foley RW, Ryan JM. Intraoperative coronary artery spasm successfully treated with nitroglycerin and nifedipine. Ann Thorac Surg 1983; 36: 97–100.
Zeff RH, Iannone LA, Kongtahworn C, Brown TM, Gordon DF, Benson M, Phillips SJ, Alley RE. Coronary artery spasm following coronary artery revascularization. Ann Thorac Surg 1982; 34: 196–200.
Ginsburg R, Stinson EB, Bristow MR, Schroeder JS. Coronary-artery spasm after revascularization. N Engl J Med 1981; 305: 699.
Vatner SF, Higgins CB, Braunwald E. Effects of norepinephrine on coronary circulation and left ventricular dynamics in the conscious dog. Circ Res 1974; 34: 812–823.
Kimura E, Kishida H. Treatment of variant angina with drugs; a survey of 11 cardiology institutes in Japan. Circulation 1981; 63: 844–848.
Schroeder JS, Lamb IH, Ginsburg R, Bristow MR, Hung J. Diltiazem for long-term therapy of coronary arterial spasm. Am J Cardiol 1982; 49: 533–537.
Shimamoto M. Surgical treatment for variant angina. Nippon Kyobu Geka Gakkai Zasshi (J Jpn Thorac Surg Soc) 1983; 31; 828–838. (English Abst.)
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Fuse, K., Makuuchi, H., Konishi, T. et al. Coronary artery spasm during coronary artery bypass surgery: Its diagnosis, treatment and prevention. The Japanese Journal of Surgery 18, 626–635 (1988). https://doi.org/10.1007/BF02471522
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DOI: https://doi.org/10.1007/BF02471522